Provider Demographics
NPI:1790548352
Name:JACOBSON, ANITA MARIE
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:ND
Mailing Address - Zip Code:58571-0312
Mailing Address - Country:US
Mailing Address - Phone:406-565-3203
Mailing Address - Fax:
Practice Address - Street 1:312 MILLER AVE.
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:ND
Practice Address - Zip Code:58571-5857
Practice Address - Country:US
Practice Address - Phone:406-565-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant